Related Experiment Video
Updated: Jul 6, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Patterns of artery disease in 450 patients undergoing revascularization for critical limb ischemia: implications for
Carlos A Rueda1, Mark R Nehler, Darryl J Perry
1University of Colorado Health Sciences Center, Aurora, CO 80045, USA.
Insights
Critical limb ischemia patients often have arterial blockages in the popliteal and tibial arteries, particularly those with diabetes or kidney disease. Understanding these patterns is key for developing new treatments.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Critical limb ischemia (CLI) is a severe manifestation of peripheral artery disease (PAD).
- Understanding the specific patterns of arterial occlusive disease is crucial for effective treatment strategies.
Purpose of the Study:
- To describe the pattern and distribution of arterial occlusions and stenoses in patients with CLI.
- To identify differences in disease patterns among patient subgroups with specific comorbidities.
Main Methods:
- Retrospective evaluation of 450 CLI patients who underwent arteriography and infrainguinal revascularization.
- Arterial tree categorized into aorta-iliac (A-I), femoral (Fem), and popliteal-tibial (Pop-Tib) segments.
- Analysis of stenoses ( <50% or >50%) and occlusions, stratified by comorbidities (diabetes mellitus, end-stage renal disease) and Fontaine stage.
Main Results:
- 55% of CLI patients had occlusive disease in the popliteal-tibial (Pop-Tib) segments.
- Popliteal and tibial occlusive patterns were prevalent (61-69%) in patients with diabetes, end-stage renal disease, and Fontaine stage IV.
- 65% of patients with Pop-Tib occlusions also had critical stenoses in proximal femoral segments.
Conclusions:
- Over half of CLI patients undergoing infrainguinal revascularization exhibit Pop-Tib occlusions, often with associated femoral stenoses.
- These occlusive patterns are more pronounced in patients with diabetes mellitus, end-stage renal disease, and advanced CLI (Fontaine stage IV).
- Knowledge of these specific arterial disease patterns is vital for advancing endovascular and angiogenesis therapies for CLI.
Objective:
The pattern and distribution of arterial occlusions and stenoses in patients with critical limb ischemia presenting at two academic medical centers was described.
Methods:
From January 1998 to December 2006, 450 consecutive critical limb ischemia patients who underwent arteriography and infrainguinal revascularization at the University of Colorado Health Sciences Center or Southern Illinois University were retrospectively evaluated. Demographics, clinical morbidities, and Fontaine stage were recorded. The arterial tree was categorized into three groups: the aorta and iliac arteries (A-I); the common femoral, superficial femoral, and profunda femoral arteries (Fem); and the popliteal and tibial arteries (Pop-Tib). Arterial segments within groups were categorized as subcritical stenoses (patent or <50% stenoses), critical stenoses (single or multiple >50% stenoses), or occluded (segmental occlusions of any length). Patients with diabetes mellitus, end-stage renal disease, and Fontaine stage (III vs IV) were analyzed for differing disease patterns according to their chart history.
Results:
Occlusive disease was present in 5% in all arterial segments (A-I + Fem + Pop-Tib), in 1% in the A-I + Fem group, in 2% in the A-I + Pop-Tib group, in 3% in A-I group, in 4% in the Fem group, in 30% in the Fem + Pop-Tib group, and in 55% in the Pop-Tib group. Descriptive comparisons among subgroups demonstrated a 61% to 69% prevalence of popliteal and tibial occlusive patterns in patients with diabetes mellitus, end-stage renal disease, and Fontaine stage IV. Furthermore, 65% of patients with Pop-Tib occlusions had associated critical stenoses in the proximal arterial groups.
Conclusion:
More than half of critical limb ischemia patients undergoing infrainguinal revascularization have arterial occlusions in the popliteal or tibial arterial segments, or both, with associated critical stenoses in the femoral arterial segments, which is even greater in the subgroups with diabetes mellitus, end-stage renal disease, and Fontaine stage IV. Knowledge of such occlusive patterns is important for the development of novel infrainguinal endovascular and angiogenesis therapies for critical limb ischemia.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Peripheral Artery Disease I: Introduction
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...